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Application of coronary artery calcium score measurement on coronary CT angiography



To verify the accuracy and the clinical application of the coronary artery calcium score measurement on coronary CT angiography (CCTA).


The study enrolled 1093 patients (56.86 ± 9.47 years old, 454 males) who underwent both coronary artery calcium score plain CT and CCTA scans from 2018 to 2019. Calcium volume (CCTA-CV) and Agatston score (CCTA-AS) were both measured from the CCTA images taking the mean aortic attenuation value pluses twice the standard deviation as the calcium detection threshold. Calcium volume (Plain CT-CV) and Agatston score (Plain CT-AS) were also measured on plain CT as the gold standard.


Pearson correlation analysis showed good correlations between the CCTA-CV and Plain CT- CV in main branches and total volume (r2 = 0.96, 0.96, 0.92, 0.93, 0.96 for LM, LAD, LCX, RCA, and total volume, respectively, ps < 0.001). CCTA-AS also correlated linearly with Plain CT-AS with a good correlation coefficient (r2 = 0.96, 0.97, 0.93, 0.94, 0.97 for LM, LAD, LCX, RCA, and total Agatston score, respectively, ps < 0.001).Radiation dose were 1.42 ± 0.13 mSv, and 1.87 ± 0.12 mSv for CCTA scan only and for Plain CT + CCTA (t = -− 11.82, p < 0.001). CCTA missed 35 cases’ calcification with the mean calcium volume = 4.59 mm3 and mean Agatston score = 2.31, while CCTA also rediscovered 13 cases’ calcification with the mean calcium volume = 3.92 mm3 and mean Agatston score = 5.21. Agatston grades Kappa between the two methods was 0.864 (p < 0.001). Additionally, age, male, diabetes mellitus, typical symptoms, smoke, and cerebrovascular disease were the impact factors for both Plain CT-AS and CCTA-AS (ps < 0.001).


Calcium volume and Agatston score can be accurately measured from CCTA images only with ~ 25% radiation dose reduction. Even though there were several missing or newly found calcification cases, CCTA-AS could indicate the risk stratification in the clinics.

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Data availability statement

All the data in the current study were patients’ data acquired in Tianjin Medical University General Hospital. The datasets generated during and/or analyzed during the current study are not publicly available due to the patients’ privacy, but are available from the corresponding author on reasonable request. Then, all the data will be provided after data desensitization.


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Author Dong Li is a member of the Editorial Board for Chinese Journal of Academic Radiology. The paper was handled by the other Editor and has undergone rigorous peer review process. Author Dong Li was not involved in the journal's review of, or decisions related to, this manuscript.


This work was supported by National Key Research and Development Project (2016YFC1300400), National Natural Science Foundation of China (82071907, 81301217, 81301202), Natural Science Foundation of Tianjin (18JCYBJC25100, 18JCQNJC80200), and Tianjin Health Science and Technology Project (MS20022).

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Correspondence to Dong Li.

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The authors do not have conflict of interest.

Ethical approval and informed consent

This retrospective study was approved by the Institutional Review Board of Tianjin Medical University General Hospital and informed consent was waived (IRB2020-KY-261). All the participant singed informed consent of CCTA examination and contrast agent use and contraindication.

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Zhang, Z., Guo, J., Deng, Y. et al. Application of coronary artery calcium score measurement on coronary CT angiography. Chin J Acad Radiol 5, 132–140 (2022).

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  • Coronary artery disease
  • Coronary artery calcium score
  • Vascular calcification
  • Computed tomography angiography